The Delaware Division of Public Health (DPH) is issuing this health advisory to provide the healthcare community with information from
the Centers for Disease Control and Prevention (CDC) on updated guidelines for evaluation of patients presenting with severe respiratory
illness that may be associated with a novel coronavirus. The CDC health advisory can be found at: http://emergency.cdc.gov/HAN/han00343.asp.

Summary

The CDC is working closely with the World Health Organization (WHO) and other partners to better understand the public health risk posed
by a novel coronavirus that was first reported to cause human infection in September 2012 in the Middle East.

Background

Novel coronavirus is a beta coronavirus that was first described in September 2012 when it was reported to have caused fatal acute lower
respiratory illness in a man in Saudi Arabia. This new virus is different from other known human coronaviruses, including the one that
caused severe acute respiratory syndrome (SARS). As of March 8, 2013, 14 laboratory-confirmed cases of novel coronavirus
infection have been reported to the WHO: Saudi Arabia (7), Qatar (2), Jordan (2), and the United Kingdom (UK) (3). Illness onset ranged
from April 2012 to February 2013. Of the 14 cases, eight were fatal. To date, no cases have been reported in the United States. Diagnosis
relies on testing for the novel coronavirus with specific polymerase chain reaction (PCR) assays available at the CDC. There is no
specific treatment for novel coronavirus infection and the only option for care is supportive management.

A cluster of illnesses is still under investigation by the UK Health Protection Agency but provides the first clear evidence of
human-to-human transmission of this novel coronavirus and of human co-infection with novel coronavirus and another respiratory pathogen
(influenza A). Additional details can be found in the March 7, 2013 MMWR Early Release (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm62e0307a1.htm?s_cid=mm62e0307a1_e).

Recommendations

Persons who develop severe acute lower respiratory illness within 10 days of travel from the Arabian Peninsula or neighboring
countries* should continue to be evaluated according to current guidelines for community acquired pneumonia. In addition, persons who meet the following criteria for “patient under investigation”
(PUI) should be reported to the Delaware Division of Public Health, Bureau of Epidemiology (24/7) at 1-888-295-5156 for evaluation for
possible novel coronavirus infection and for coordination of laboratory testing with the CDC:

History of travel from the Arabian Peninsula or neighboring countries* within the preceding 10 days; AND

Evidence of acute respiratory infection, which may include fever (≥ 38°C , 100.4°F) and cough; AND

Signs, symptoms and radiologic features not explicable by other infectious or non-infectious etiology, after conducting all
clinically indicated tests for community-acquired pneumonia† .

In addition, the following persons may be considered for evaluation for novel coronavirus infection:

Persons who develop severe acute lower respiratory illness due to a known etiologic agent but who do not respond to appropriate
therapy targeted at that agent and whose symptoms started within 10 days of travel from the Arabian Peninsula or neighboring countries*;
OR

Persons who develop severe acute lower respiratory illness and who are close contacts‡of a symptomatic traveler who
developed fever and respiratory illness within 10 days of travel from the Arabian Peninsula or neighboring countries.*

* Countries considered to be on or neighboring the Arabian Peninsula include Bahrain, Iraq, Iran, Israel, Jordan, Kuwait, Lebanon,
Oman, Palestinian territories, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE), and Yemen.

† Examples of respiratory pathogens that commonly cause community-acquired pneumonia and for which laboratory testing
can be done when indicated include influenza A and B, respiratory syncytial virus, adenovirus, Streptococcus pneumoniae, and
Legionella pneumophila.

‡ Close contact is defined as 1) any person who provided care for the patient, including a health-care worker or family
member, or who had other similarly close physical contact, or 2) any person who stayed at the same place (e.g., lived with or visited) as
the patient while the patient was ill.